On Wednesday, January 16, the Governor introduced his proposed FY 2014 budget.  The total budget is $37.3 billion, which represents a 4% increase over FY 2013.  Health care spending is the state's largest expenditure, comprising 28% of the budget ($10.3 billion).  At $7.4 billion, elementary and secondary education is the second largest state expenditure.  The budget recognizes the potential state impact of federal sequestration by providing for a total cash reserve of $1.1 billion.  With this budget, the state's structural budget gap is reduced to $166 million.  

Health
� The FY 2014 budget has no direct cuts to hospitals, MCO rates or provider rates.
� Hospital assessment.  The assessment is not increased and remains at $413 million.
� Outpatient observation.  The budget calls for Medicaid to deny payment for hospital services provided to a patient who is under outpatient observation for more than 48 hours.  The savings to Medicaid is estimated to be a total of $2 million in state and federal funds.  
� Outpatient "tiering."  The budget calls for HSCRC to ensure that outpatient tiering realizes the $30 million in savings anticipated by Medicaid when tiering was enacted in last year's budget.  If not, the current Maryland Health Insurance Plan assessment or other HSCRC savings could be redirected to fill the remaining funding gap.  
� The update factor.  The budget assumes a hospital update factor of 0.3%, which is the same as last year's HSCRC approved update factor.  The HSCRC is not bound to this budgeted assumption.
� Medicaid.  Funding grows (3%) to $7.4 million.  This growth is attributed to the additional federal funds for the January 1, 2014, Medicaid expansion.

Higher Education
� Sellinger.  Funded at $41.3 million for FY 2014.  This represents an 8% increase over the prior fiscal year's Sellinger funding and is consistent with the formula approved by the Maryland General Assembly last legislative session.

Research & Technology
� Biotechnology Tax Credit.  Funded at $10 million, a $2 million increase over FY 2013.
� Cigarette Restitution Fund to Academic Medical Centers.  The CRF returns to the statutory funding level of $13 million.  Johns Hopkins will receive $1,793,103 and University of Maryland Medical Center will receive $11,206,897.
� Stem Cell Research Fund.  This program is level funded at last year's appropriation of $10.4 million.
� Invest Maryland.  The budget includes $25.6 million for the Maryland Enterprise Investment Fund and Challenge Program to invest in emerging high technology businesses.
� CyberMaryland Investment Incentive Tax Credit.  This year's budget includes $3 million for a new program that is intended to attract private investments in early-stage cyber security technology businesses in Maryland.

The legislature will spend the coming weeks holding public hearings on every aspect of the spending plan.  The Governor's proposal represents the first step in the process, and the bill will be taken up first by the House of Delegates this year.  The budget will not be finalized until it is passed by both chambers of the legislature later this spring.


Capital Budget

As introduced, the capital budget includes the following projects with direct ties to Johns Hopkins:
� High performance computing.  The capital budget includes $12 million for the construction of a world class computational research facility, to be located adjacent to the Bayview Medical Campus and to be managed under an agreement between Johns Hopkins University and the University of Maryland, College Park.  This is the second installment of state funding for this project, which is slated to receive a total of $30 million over three fiscal years.
� Malone Hall.  The capital budget includes $4 million to support the construction of Malone Hall on the Homewood campus.
� Bayview Medical Center.  The capital budget includes $975,000 to support the emergency department expansion and renovation at Bayview.

State Affairs will work with our allies in the General Assembly to ensure that these funds are protected as the legislature makes its capital budget decisions later this spring.


Administration Public Safety Legislative Package

In a press release announcing his administration's public safety legislation this session, the Governor included a quotation from Professor Daniel Webster, Director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health: "I applaud Governor O'Malley's leadership to prevent gun violence.  Research supports that purchaser licensing systems are the most effective approaches to curtailing illegal straw purchases and gun trafficking."  The Governor's package focuses on three areas: gun safety, school safety, and improving mental health safeguards and services.  In addition to stronger licensing requirements, proposals will be introduced to ban all assault weapons, increase limitations on magazine capacity, dedicate $25 million of school construction funds to school security measures, increase information sharing for background checks, improve mental health services, and establish a Task Force to Improve Continuity of Care for Individuals in the Community Mental Health System.


Committee Re-assignments

The presiding officers announced several committee membership changes at the beginning of session.  In the Senate, C. Anthony Muse (Prince George's County) has moved back to the Judicial Proceedings Committee from the Finance Committee.  Victor Ramirez (Prince George's County) has moved to the Finance Committee from the Judicial Proceedings Committee.

In the House of Delegates, Galen Clagett (Frederick County) has moved to the Economic Matters Committee from the Appropriations Committee.  Glen Glass (Cecil & Harford Counties) and Samuel Rosenberg (Baltimore City) have both moved from the House Ways & Means Committee to the Judiciary Committee.  Don Dwyer (Anne Arundel County) has moved to the Ways & Means Committee from the Judiciary Committee, and newly appointed Delegate Alonzo Washington (Prince George's County) will also join the Ways & Means Committee.


Economic Forecast Briefing

On Tuesday, January 15, Mark Zandi (Chief Economist for Moody's Analytics) briefed the Senate Budget & Taxation Committee on the direction of the US and Maryland economies.  He is optimistic regarding economic growth in 2014-2015, provided that nothing politically chaotic occurs at the federal level.  His presentation included praise for Johns Hopkins' position as an economic engine in the state, referring to Johns Hopkins Medicine as "the best on the planet" and noting that Johns Hopkins University "gets people from all over the world, really, the best of the world."  His remarks were offered in the context of his view that supporting educational attainment and the skills of the population is one of the most powerful things the state can do to strengthen its long-run economic prospects.


Health Enterprise Zones Announced

On January 24, Lt. Governor Anthony Brown announced locations of the state's first five Health Enterprise Zones (HEZs): Capitol Heights (Prince Georges County), Greater Lexington Park (St. Mary's County), Dorchester and Caroline Counties, west Baltimore City, and Annapolis.  HEZs are defined geographic areas with measurable health disparities.  The HEZs initiative is a four-year pilot program created through the Maryland Health Improvement and Disparities Reduction Act of 2012 and is funded with $4 million annually.   Community coalitions will receive various incentives, benefits, and grant funding to address health disparities within each designated HEZ.  Nineteen coalitions applied for HEZ designation.  Johns Hopkins participated as a collation member in an east Baltimore City HEZ application, which was not selected.


Medicare Waiver Briefing

A briefing on the status of the state's Medicare waiver was held before the Senate Budget & Taxation and Finance Committees on January 22.  Stuart Erdman presented the hospital perspective with Carmela Coyle (Executive Director of the Maryland Hospital Association) and Bob Chrencik (CEO of the University of Maryland Medical System).  The hospitals expressed their commitment to maintaining the state's waiver, but urged that any waiver redesign must pursue a balanced approach.  In their update, the Health Services Cost Review Commission and the Department of Health and Mental Hygiene informed the committees that the state is close to failing the current waiver test and is negotiating with Centers for Medicare & Medicaid Services for a new waiver test.  All briefing participants reminded the committee members that the current waiver results in $1.5 billion of additional Medicare payments to Maryland hospitals.


CMMI Grant Briefing

The House Health & Government Operations Committee held a briefing on Center for Medicare & Medicaid Innovation grants on January 22.  Dr. Constantine Lyketsos and Dr. Scott Berkowitz briefed the committee on the Johns Hopkins Community Health Partnership, and Professor Sarah Szanton briefed the committee on the CAPABLE program.  Lawmakers expressed enthusiasm for the development of new models of patient-centered care and expressed hope that the models will prove to be effective and sustainable.


Education Briefing

On January 24, Dean David Andrews came to Annapolis to provide a briefing to the Senate Education, Health, & Environmental Affairs Committee.  The Dean's presentation focused on the future of education and outlined best practices for achieving successful student outcomes.  The Dean also discussed Henderson-Hopkins, the Johns Hopkins K-8 elementary/middle partnership school currently under construction in East Baltimore.  The committee members were very engaged in the discussion and praised Dean Andrews for his efforts at both the School of Education and Henderson-Hopkins. Dean Andrews will return to Annapolis on January 31 to provide a presentation to the House Ways & Means Committee


Maryland Health Progress Act

Governor Martin O'Malley has introduced the Maryland Health Progress Act of 2013.  This legislation would expand Medicaid eligibility to 133% of the federal poverty level, and establish many details of the Health Benefit Exchange, including a funding stream and rededication of certain hospital assessment revenues

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BILLS INTRODUCED

Budget - Capital

HB0101 Creation of a State Debt - Maryland Consolidated Capital Bond Loan of 2013, and the Maryland Consolidated Capital Bond Loans of 2006, 2007, 2008, 2009, 2010, 2011, and 2012

The annual capital budget bill authorizes the creation of new state debt in the amount of $1,103,006,000, for various state and public interest capital projects.

Effective Date: Various
For more information, please contact: Nicki McCann

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Budget - Operating

HB0100 Budget Bill (Fiscal Year 2014)

The fiscal year 2014 budget provides for $37.3 billion in approrpiations.

Effective Date:
For more information, please contact: Nicki McCann

HB0102 Budget Reconciliation and Financing Act of 2013

The Budget Reconciliation and Financiong Act of 2013 is the campanion bill to the budget bill.  This bill addresses changes to statutory funding levels and fund balance transfers.

Effective Date: Various
For more information, please contact: Nicki McCann

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Health Care Facilities

SB0151 Hospitals - Outpatient Services - Off-Site Facility - Rate Regulation

Current statute allows certain off-site outpatient facilities to be subject to HSCRC approved rates, if the hospital provided notice to the HSCRC that they wanted the outpatient facility to be subject to HSCRC rates by July 1, 1999.  This bill changes the notification date to June 1, 2013.  This bill is intended to address a specific issue at Easton Memorial Hospital, but it does open up the HSCRC statute.

Effective Date: Emergency Measure
For more information, please contact: Nicki McCann

SB0195 Hospitals - Notice to Patients - Outpatient Status and Billing Implications

This bill requires a hospital, under specified circumstances, to provide notice to a patient of the patient's outpatient status, the billing implications of the outpatient status, and the impact of the outpatient status on the patient's eligibility for Medicare rehabilitation services.  A hospital is rquired to provide notice if: 1) the patient receives on-site services from the hospital for more than 18 consecutive hours, 2) the on-site services received by the patient include a hospital bed and meals that have been provided in an area of the hospital other than the emergency room, and 3) the patient is classified as an outpatient at the hospital for observation rather than an admitted inpatient.  The bill also requires the Department of Health and Mental Hygiene to adopt by regulation standard language for a specified written notice.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

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Health Care Occupations

HB0180 Medical Marijuana - Caregiver - Affirmative Defense

HB 180 establishes that it is an affirmative defense, in a prosecution for the possession of marijuana or related paraphernalia, that the defendant possessed marijuana or paraphernalia because the defendant was a caregiver and the marijuana or paraphernalia was intended for medical use by an individual with a debilitating medical condition.  The bill specifies that the affirmative defense may not be used if the defendant was using (or assisting in the use of) marijuana in a public place or was in possession of more than one ounce of marijuana.  In addition, the bill specifies that a defendant may assert the affirmative defense only if the defendant: (1) notifies the State's Attorney, at least 30 days before trial, of the defendant's intention to assert the affirmative defense; and (2) provides the State's Attorney with all documentation in support of the affirmative defense.

Effective Date: June 1, 2013
For more information, please contact: Delora Sanchez

SB0139 Health Care Practitioners - Prescription Drug or Device Dispensing - Medical Facilities or Clinics That Specialize in Treatment Reimbursable Through Workers' Compensation Insurance

Under current law, a dentist, physician, or podiatrist is exempted from obtaining a license issued by the Board of Pharmacy before dispensing a prescription drug if a prescription drug or device is dispensed in the course of treating a patient at a medical facility or clinic that specializes in the treatment of medical cases reimbursable through workers' compensation insurance to obtain a dispensing permit and meet other requirements.  This bill repeals the exception.

Effective Date: July 1, 2013
For more information, please contact: Nicki McCann

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Health Reform

SB0274 Maryland Health Progress Act of 2013

SB 274: 1) expands Medicaid to 133% of federal poverty; 2) establishes a dedicated funding stream for the Maryland Health Benefit Exchange (MHBE or Exchange) from the existing premium tax on health insurers; 3) provides for the migration of enrollees of the Maryland Health Insurance Plan (MHIP) into the Exchange in a manner that eases their transition and mitigates the potential impact on rates; 4) allows for the development of a State reinsurance program to counteract potential short-term pressures on rates; 5) puts in place policies to promote continuity of care for those switching insurance policies and moving in and out of Medicaid and commercial insurance; and 6) makes other changes necessary for the MHBE to achieve final certification as a state-based exchange.

Effective Date: Various
For more information, please contact: Nicki McCann

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Health, General/Public/Environmental

HB0057 Department of Health and Mental Hygiene - Health Care Facilities - Abuser Registry

This bill requires DHMH to establish a registry that includes the name and social security number of any employee who has been terminated for abusing or neglecting a senior citizen, a disabled individual, a developmentally disabled individual, an individual receving care by an in-home aide or an individual incapable of self-defense.  The employee shall be placed on the registry if an investigation has been completed by both the health care facility and an appropriate authority, the abuse has been deemed to have occurred, the employee has been terminated and no charges have been filed.  A health care facility may not employ someone on the registry.  

Additionally, each hospital will be required to adopt an employee grievance procedure, provide training on the proper handling of confidential information, and implement a quality assurance program aimed at preventing a former employee from being recommended for inclusion in the registry.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

HB0067 Health Care Decisions Act - Incapacity to Make Informed Decision - Certification by Psychologist

This bill alters the certification requirement regarding a patient's incapacity to make an informed decision regarding treatment to allow the second individual making the certification to be a psychologist, rather than a second physician.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

HB0099 Public Health - Child Care Products Containing Flame-Retardant Chemicals (TRIS) - Prohibition

This bill prohibits a person from selling or offering for sale any child care product that contains "TRIS," which, under the bill, means tris (2-chloroethyl) phosphate (TCEP), a flame retardant chemical.  A "child care product" is a consumer product - including a baby product, toy, car seat, nursing pillow, crib mattress, or stroller - intended for use by a child younger than age four.  (The bill does not apply to the sale or distribution of a child care product that is resold, offered for resale, or distributed by a consumer for consumer use.)

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

HB0149 Baltimore City - AIDS Prevention Sterile Needle and Syringe Exchange Program

Repeals a requirement that the AIDS Prevention Sterile Needle and Syringe Exchange Program in Baltimore City provide for the exchange of used hypodermic needles and syringes for sterile hypodermic needles and syringes on a one-for-one basis.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

HB0171 Motor Vehicle Administration - Organ Donation - Presumed Consent (Patricia Hanberry Gift of Life Act)

This bill changes the current organ donation process administered by the Motor Vehicle Administration from an opt-in program to an opt-out program.  The bill also requires the Administration to provide for a method by which someone can designate that they no longer wish to be an organ donor and requires the Administration to indicate whether an individual is an organ donor on the individual's driver's license or identification card.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

SB0094 Child Abuse and Neglect - Notice and Reporting Requirements, Disclosure, and Task Force

This bill makes it a misdemeanor for a worker in a professional capacity who is required to report suspected abuse to knowingly and willfully fail to provide the required report under specified circumstances. The bill establishes immunity from civil liability and criminal penalties for workers who in good faith provide or participate in providing notice of abuse or neglect as required, and requires certain entities to have a policy relating to child abuse and neglect and to provide employees and contractors with information on reporting same.  It also provides that a report concerning child abuse or neglect may be disclosed on request to institutions of higher education and establishes the Task Force to Study Training for School Employees and Volunteers on the Prevention, Identification, and Reporting of Child Sexual Abuse.

Effective Date: Various
For more information, please contact: Matt Greenwood

SB0114 Health - Pregnant Women - Hepatitis B Testing

This bill requires an individual attending a woman for pregnancy to submit to a medical laboratory a blood sample taken from the woman (1) when the individual first examines the woman; and (2) if the woman did not have prenatal services or there is no documentation of the woman's hepatitis B status, at the time of delivery.  The bill specifies that the laboratory receiving the blood sample must perform a standard hepatitis B test that is approved by the Department of Health and Mental Hygiene (DHMH).

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

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Miscellaneous

HB0116 Courts and Judicial Proceedings - Interception of Communications - Abuse or Neglect of Vulnerable Adult and Medicaid Fraud

This bill adds abuse or neglect of a vulnerable adult and offenses relating to Medicaid fraud to those crimes for which specified evidence may be gathered by, and a judge may grant an order authorizing, interception of oral, wire, or electronic communications.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

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Prescription Drugs

SB0166 Dentists, Physicians, and Podiatrists - Dispensing Prescription Drugs - Inspection by Division of Drug Control

Alters the requirement that the Division of Drug Control enter and inspect the office of a dentist, physician, or podiatrist who holds a permit to dispense prescription drugs from at least once to at least annually during the duration of the permit.

Effective Date: October 1, 2013
For more information, please contact: Nicki McCann

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Workplace Regulation

HB0055 Labor and Employment - Sick Leave Policy - Requirement

HB 55 requires an employer to have a sick leave policy under which an employee of the employer earns a specified number of sick leave days each month based on the number of hours worked. The sick leave policy must contain a provision relating to sick leave abuse prevention by employees.   An employer is defined as a person engaged in a business, industry, profession, trade, or other enterprise in the state, including a person who acts directly or indirectly in the interest of another employer. State agencies are not affected.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0104 Occupational Safety and Health - Good Faith Actions by Business Owners - Penalty Forgiveness

HB 104 prohibits the Commissioner of Labor and Industry from assessing a civil penalty against an employer for certain violations of the Maryland Occupational Safety and Health Act. This Includes certain orders passed under the Act and certain regulations adopted to carry out the Act.  A penalty will be forgiven and the commissioner may not assess a civil penalty if: the commissioner has not previously issued a citation to the employer for any violation; the violation is not a serious one; and the employer corrects the violation within a reasonable period of time.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0189 Courts - Peace Orders - Acts Committed Against Employees

HB 189 alters the definition of "petitioner" for peace order by authorizing a petitioner to file a peace order for certain acts committed against the petitioner's employee.  Authorizes a District Court commissioner to issue an interim peace order, temporary peace order or final peace order to protect a petitioner's employee under certain circumstances.  The bill would not alter the duty of an employer to provide a safe workplace for employees and other persons.  An employer that files a peace order will be presumed to be acting in good faith and is immune from civil liability.  The failure of an employer not to file a peace order is not negligence nor is admissible as evidence of negligence.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0281 Determination of Unemployment Insurance Benefits - Voluntarily Leaving Work - Valid Circumstances

HB 281 prohibits the Secretary of Labor and Employment, except under specified circumstances, from finding that a valid circumstance for voluntarily leaving work exists under a specified provision of law if an individual leaves work solely due to a reduction in wages.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0283 Unemployment Insurance - Appeal of Benefit Determination - Discovery of Financial Crime

HB 283 authorizes an employer to file an appeal with the Lower Appeals Division within 15 days after the employer discovered, or should have discovered, that an individual receiving benefits committed a financial crime against the employer while employed by the employer.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0348 Unemployment Insurance - Employer Contributions - Application for Refund or Adjustment

HB 348 will extend the time period during which an employer may apply to the Secretary of Labor, Licensing, and Regulation for an adjustment to unemployment insurance contributions due or a refund of unemployment contributions or interest paid.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

HB0354 Unemployment Insurance - Recovery of Benefits - Monetary Penalty for Fraud

HB 354 will authorize  the Secretary of Labor, Licensing, and Regulation to recover from a claimant a specified monetary penalty under specified circumstances; altering the amount of interest the Secretary may recover under specified circumstances; specifying how specified funds recovered by the Secretary are to be applied; requiring a person who violates a specified provision of law to pay a specified monetary penalty; excluding specified monetary penalties from the amount that can be recovered by the Secretary through a specified method; etc.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

SB0012 Labor and Employment - Leave - Deployment of Family Members in the Armed Forces

SB 12 requires employers, including the state and local governments, to allow an employee to take leave from work on the day that an immediate family member is leaving for or returning from active military duty outside the United States.  "Immediate family members" is defined as a spouse, parent, stepparent, child, stepchild, or sibling.  Employers may not require an employee to use accrued compensatory, sick, or vacation leave for this purpose.  Employers may require the employee to submit proof that the leave is being taken in accordance with the bill.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez

SB0311 Workers' Compensation - Temporary Total Disability Benefits - Credit

SB 311 will provide a credit for an employer or insurer for specified payments to a covered employee for temporary total disability benefits under specified circumstances and during a specified period.

Effective Date: October 1, 2013
For more information, please contact: Delora Sanchez


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